Aggressive Lipid Management for Diabetes

Size: px
Start display at page:

Download "Aggressive Lipid Management for Diabetes"

Transcription

1 Aggressive Lipid Management for Diabetes Practical Ways to Achieve Targets in Diabetes Care Keystone, CO July 16, 2011 Robert H. Eckel, M.D. Professor of Medicine Professor of Physiology and Biophysics Charles A. Boettcher II Chair in Atherosclerosis University of Colorado Anschutz Medical Campus

2 Duality of Interests Advisory Boards, Consultant Amylin Esperion Genentech Genfit GTC Nutrition Johnson & Johnson Lilly Merck Pfizer Regulus sanofi-aventis Grants/Research Fellowships Diadexus GSK sanofi-aventis Educational Venues AccelMed Cardiometabolic Health Congress Vindico

3 Age-Adjusted CVD Death Rate per 10,000 py Influence of Multiple Risk Factors on CVD Death Multiple Risk Factor Intervention Trial No Diabetes Diabetes RFs: Smoking Hyperlipidemia Hypertension None One Only Two Only All Three Stamler J et al, Diabetes Care 1993;16:

4 Pathogenesis of Increased Atherosclerosis in Diabetes Metabolic factors Glucose Fatty acids Lipoproteins Inflammation Oxidation/Glycoxidation Endothelial dysfunction Pro-thrombotic state thrombosis fibrinolysis

5 What Are the Risk Factors for CVD in Patients with Type 2 Diabetes? Hypertension Dyslipidemia Glycemia Inflammation Thrombosis

6 What Are the Risk Factors for CVD in Patients with Type 2 Diabetes? Hypertension Dyslipidemia Glycemia Inflammation Thrombosis

7 Let s start with Type 2 Diabetes

8 BMJ 316:823-29,1998 UKPDS CHD (n=280) Stepwise Selection of Risk Factors Adjusted for Age and Sex Position in Variable P value Model First LDL-C < Second HDL-C Third Hb A 1c Fourth SBP Fifth Smoking 0.056

9 CHD Hazard Ratios BMJ 316:823, 1998 UKPDS: CHD Hazard Ratios and LDL Cholesterol CHD MI 0 < >150 LDL Cholesterol (mg/dl)

10 CHD Hazard Ratios BMJ 316:823, 1998 UKPDS: CHD Hazard Ratios and Triglycerides < >168 CHD MI Triglycerides (mg/dl)

11 Mean Annual CHD Mortality Rate/1000 Fasting TGs and Risk for CHD Death The Paris Prospective Study 6 TG 123 mg/dl TG>123 mg/dl > >220 Cholesterol (mg/dl) Adapted from Fontbonne A et al. Diabetologia 32:300,1989

12 CHD Hazard Ratios UKPDS: CHD Hazard Ratios and HDL Cholesterol < >44 CHD MI HDL Cholesterol (mg/dl) BMJ 316:823-29,1998

13 Liu J et al, Diabetes Care 28:1916, 2005 LDL vs. Non-HDL Cholesterol in Patients with T2DM: FCS, FOS, LRCF, and MRFIT N = 12,660 men & 6,721 women

14 Lipoproteins in Patients with Type 2 Diabetes Metabolic Syndrome-Like TG VLDL-C remnant/idl-c HDL-C apo A-1 ± LDL-C ± apo B Lipoprotein (a) renal disease Lipoprotein density LDL HDL

15 Patients with diabetes (%)* Modified from Jacobs MJ et al. Diabetes Res Clin Pract. 70:263, 2005 High Incidence of Dyslipidaemia in Patients with Diabetes 100% 80% <100 <150 Men >40 Women >50 60% % 20% Men 40 Women 50 0% Men Women Men Women Men Women LDL-C (mg/dl) Triglycerides (mg/dl) HDL-C (mg/dl) *245 men with diabetes and 253 women with diabetes aged 18 years from NHANES

16 Can CVD Risk be Reduced in Patients with T2DM?

17 CVD Primary Prevention with Statins in T2DM Study Drug n LDL-C LDL-C % MI % CVD Mort% CARDS Atorva 10 mg mg/dl 40 RRR 35* RRR 38* ASPEN Atorva 10 mg mg/dl 30 RRR 19* RRI 25 HPS Simva 40 mg mg/dl 31 RRR 25* RRR 20* ASCOT- LLA Atorva 10 mg mg/dl 29 RRR 16 RRI 24

18 Patients with Major Cardiovascular Event (%) Deedwania, P. et al. Lancet 2006;368: TNT: Substantial Risk Persists Despite Maximal Dose Statin in Patients With CHD All Metabolic Syndrome Atorvastatin 10 mg (N=2820) Atorvastatin 80 mg (N=2764) P< All Metabolic Syndrome, No Diabetes Atorvastatin 10 mg (N=2191) Atorvastatin 80 mg (N=2162) P= Time to First Major Cardiovascular Event (years) TNT=Treating to New Targets; CHD=coronary heart disease

19 Fibrate CVD Trials in T2DM Study Drug n TG (Criteria) TG Primary Endpoint VA-HIT Gemf mg/dl 31% 24%* (DM) (550) (<300) BIP Beza mg/dl 21% 7% (DM) (330) (<300) FIELD (DM) ACCORD- LIPID (DM) Feno mg/dl (90-450) Feno mg/dl (<400) 29% 11% 20% 8%

20 Goldberg IJ et al, ATVB April 2011 Epub Hypertriglyceridemia: The Problems The genetic disorders are largely without genes. The acquired disorders are almost infinite in number. The clinical trials with TG lowering drugs have suffered: design number results are hypothesis-generating at best Is it the TG-rich particles that confer risk for atherosclerotic CVD and/or the company they keep?

21 FIELD Study: Fenofibrate and the Metabolic Syndrome and CVD Event Risk Adjusted for age, gender, and A1c Scott R et al, Diabetes Care 32:493, 2009

22 Density (g/ml) Lipoprotein Classes 0.95 VLDL IDL 1.02 LDL Chylomicrons Remnants HDL 3 HDL 2 Apo B Containing Diameter (nm)

23 Coronary Drug Project: 15-Year Mortality Results Niacin n=1,119 Placebo n=2,789 Risk Reduction P Total Mortality 52% 58% -11% <0.005 FBG < 100 mg/dl 48% 53% -9% <0.05 FBG 100 mg/dl 56% 63% -12% <0.005 CHD Mortality 36% 41% -12% <0.01 Canner PL et al, J Am Coll Cardiol. 8:1245, 1986.

24 Coronary Drug Project: Niacin in patients with diabetes post hoc analysis at 15 yr demonstrates benefit. Is it secondary to HDL?

25 What about Lipids and Type 1 Diabetes?

26 Goals Determine the prevalence of coronary calcification in Type 1 Diabetes Identify risk factors for coronary calcification in Type 1 Diabetes Measure progression of coronary calcification in Type 1 Diabetes

27 Lipids (mg/dl) Lipid Levels Adjusted for Age and Waist/Hip Ratio in Women with T1DM: CACTI (n=354) (n=382) * p < 0.01 for all TC LDL HDL Trig Non-DM T1-DM Wadwa RP et al, Diabetes Care, 28:1051, 2005

28 Lipids (mg/dl) Lipid Levels Adjusted for Age and Waist/Hip Ratio in Men with T1DM: CACTI (n=298) (n=382) * p < for all Non-DM T1-DM 50 0 TC LDL HDL Trig Wadwa RP et al, Diabetes Care, 28:1051, 2005

29

30 Petitti DB et al, Arch Ped Adol Med 161:159, 2007 Serum Lipids and HbA1c: Search of Diabetes in Youth Study

31 Lipid-Related Risk Factors for CHD in Type 1 Diabetes: EDC No CHD (n=59) Age (years) 35.0 (6.0) 34.5 (6.0) A1c (%) 10.5 (1.5) 10.7 (1.8) Total Cholesterol (mm) 4.87 (0.83) 5.17 (1.18) CHD (n=59) Triglycerides (mm) 0.72 ( ) 1.17 ( ) *** HDL Cholesterol (mm) 1.51 (0.33) 1.26 (0.32) *** LDL Cholesterol (mm) 2.96 (0.78) 3.26 (1.03) Non-HDL Cholesterol (mm) 3.36 (0.89) 3.91 (1.22)** Apo B (mg/dl) 95 (19) 112 (31)*** Apo A-1/Apo B 2.49 (0.59) 2.90 (0.67)*** Soedamah SS et al, Diabetologia 46:674, 2003

32 Metabolic Phenotypes and Risk of Premature Death: FinnDiane (n = 4197) Makinen V-P et al, Diabetes 57:2480, 2008

33 What is it about the metabolic syndrome in patients with T1DM that confers the increased risk for CHD?

34 JAMA, 1998

35 Purnell, J.Q. et al Diabetes 44: 1220, 1995 Patients with Type 1 Diabetes in DCCT Conventional Intensive p HbA1c (%) < TG (mg/dl)) <0.01 LDL-C Apo B Lp(a) BMI (kg/m 2 ) x10-14

36 Clinical Characteristics: DCCT Cohort at Year 11 of EDIC INTENSIVE CONVENTIONAL Age 45 yr 45 yr Duration of DM 24 yr 23 yr Cigarettes 14% 11% BMI 28.4 kg/m kg/m2 BP 120/75 121/75 Hypertension 38% 41% Beta blockers 3% 7% ACE inhibitors 38% 41%

37 Clinical Characteristics: DCCT Cohort at Year 11 of EDIC INTENSIVE CONVENTIONAL LDL-C 112 mg/dl 109 mg/dl Non-HDL-C 131 mg/dl 126 mg/dl HDL-C 55 mg/dl 55 mg/dl Statins 34% 33% AER 54 mg/24 hr 116 mg/24 hr* > 300 mg/24 hr 2% 6% Creat > 2.0 0% 2% A1c 7.9% 7.8%

38 Martin et al, BMJ 2:81, 1968 Is Insulin Resistance in T1DM a New n = 51 Insulin tolerance test - Glucose assimilation index derived from rate of glucose decrease after IV insulin Subjects: All BMI < 30 Duration years 3 with TGs > 150 Insulin dose: units/day Insulin resistance independent of glycemic control Concept?

39 Type 1 Female Non-DM Female Type 1 Male Non-DM Male n Age 44±9 44±8 47±10 47±6 Duration 22±8 NA 23±8 NA BMI 25.8± ± ± ±3.6 TG 69±42* 99±40 70±22* 126±73 HDL-C 56±13 57±10 61±30* 45±9 LDL-C 66±25* 95±29 70±25* 101±25 Statins 52%* 9% 68%* 15% OCP 86% 73% NA NA A1c 7.5±0.9* 5.4± ±0.8* 5.4±0.3

40 GIR (mg/kg FFM/min CACTI Clamp Study Results * ** 0 Type1 control Type 1 control Female Male Adjusted for age, visceral fat area, fasting glucose, final clamp glucose and insulin. * P <0.0001; ** P<0.001 vs. same-sex controls;

41 GIR (mg/kg FFM/min Insulin Resistance is not Correlated with Glycemic Control < > >8.1 Hemoglobin A1c quartile/range (%) Schauer IE et al, Diabetes, 60: , 2011

42 NEFA (µm) NEFA Level by Time and Diabetes Status Clamp FFA * * diabetics controls * * mU/m 2 /min 8mU/m 2 /min 40mU/m 2 /min Clamp Time (minutes) * p < ; Least square means adjusted for age, BMI, gender, starting glucose concentration, and time point insulin level. Schauer IE et al, Diabetes, 60: , 2011

43 Insulin Resistance and Clamp FFA Correlate with CAC Spearman correlation coefficients (p-value) between measures of IR and measures of CAC: GIR (mg/kg/min) Stage 1 FFA Stage 2 FFA CAC volume (visit 3) CAC progression (baseline to v3) CAC progression (visit 2 to v3) (0.0026) (0.0007) (0.0073) 0.30 (0.054) 0.32 (0.04) 0.31 (0.047) 0.39 (0.01) 0.43 (0.005) 0.40 (0.0097)

44 Nadeau K et al, JCEM 95:513, 2010 Insulin Resistance in Adolescents with Type 1 Diabetes

45 IR Tertiles highest vs. lowest Maahs DM et al, Diabetes 59:1, 2010 T1D T1D Non-DM Non-DM

46 What about CVD risk reduction in T1DM by lipid management?

47 Effects of Simvastatin on First Major CVD Event in Diabetes: HPS HPS Collaborative Group, Lancet 361:2010, 2003

48 What Are the Cholesterol Goals in Diabetes? LDL cholesterol < 100 mg/dl always? Non-HDL cholesterol < 130 mg/dl always? VLDL cholesterol TG < 150 mg/dl? HDL cholesterol > 40 men? > 50 women?

49 ADA/ACC Lipid Goals LDL-C Non- Apo B HDL-C CHD or DM + 1 Risk Factor < 70 mg/dl < 100 mg/dl < 80 mg/dl 2 Risk Factors or DM < 100 mg/dl < 130 mg/dl < 90 mg/dl Brunzell JD et al, JACC 51:1512, 2008

50 NHLBI Clinical Guidelines for CVD Risk Reduction: Organizational Structure NHLBI Director DARD Director Guideline Leadership Group SAIC Support Contract DARD Project Team Clinical Guidelines Executive Committee Cross-Cutting Workgroups Risk Assessment Lifestyle/Nutrition/PA Expert Panel for the Integrated CVD Guideline Development Expert Panel for Cholesterol Updates Expert Panel for Hypertension Updates Expert Panel for Obesity Updates Implementation/System/I T/ Informatics

51 Until ATP-IV (Opinion) Type 2 Diabetes Statin for all Fibrate when fasting TG > 200 mg/dl Type 1 Diabetes Statin to lower LDL-C to < 100 mg/dl Otherwise ATP-III guidelines

Review of guidelines for management of dyslipidemia in diabetic patients

Review of guidelines for management of dyslipidemia in diabetic patients 2012 international Conference on Diabetes and metabolism (ICDM) Review of guidelines for management of dyslipidemia in diabetic patients Nan Hee Kim, MD, PhD Department of Internal Medicine, Korea University

More information

Update On Diabetic Dyslipidemia: Who Should Be Treated With A Fibrate After ACCORD-LIPID?

Update On Diabetic Dyslipidemia: Who Should Be Treated With A Fibrate After ACCORD-LIPID? Update On Diabetic Dyslipidemia: Who Should Be Treated With A Fibrate After ACCORD-LIPID? Karen Aspry, MD, MS, ABCL, FACC Assistant Clinical Professor of Medicine Warren Alpert Medical School of Brown

More information

There are many ways to lower triglycerides in humans: Which are the most relevant for pancreatitis and for CV risk?

There are many ways to lower triglycerides in humans: Which are the most relevant for pancreatitis and for CV risk? There are many ways to lower triglycerides in humans: Which are the most relevant for pancreatitis and for CV risk? Michael Davidson M.D. FACC, Diplomate of the American Board of Lipidology Professor,

More information

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Ischemic Heart and Cerebrovascular Disease Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Relationships Between Diabetes and Ischemic Heart Disease Risk of Cardiovascular Disease in Different Categories

More information

Cardiovascular Complications of Diabetes

Cardiovascular Complications of Diabetes VBWG Cardiovascular Complications of Diabetes Nicola Abate, M.D., F.N.L.A. Professor and Chief Division of Endocrinology and Metabolism The University of Texas Medical Branch Galveston, Texas Coronary

More information

Case Presentation. Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer

Case Presentation. Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer Case Presentation Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer Case Presentation 50 YO man NSTEMI treated with PCI 1 month ago Medical History: Obesity: BMI 32,

More information

Management of LDL as a Risk Factor. Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil

Management of LDL as a Risk Factor. Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil Management of LDL as a Risk Factor Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil Disclosure Consulting for: Merck, Astra Zeneca, ISIS- Genzyme, Novo-Nordisk, BMS, Pfizer,

More information

LDL cholesterol and cardiovascular outcomes?

LDL cholesterol and cardiovascular outcomes? LDL cholesterol and cardiovascular outcomes? Prof Kausik Ray, BSc (hons), MBChB, FRCP, MD, MPhil (Cantab), FACC, FESC Professor of Cardiovascular Disease Prevention St Georges University of London Honorary

More information

Cardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes

Cardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes Cardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes Following this presentation, you will be able to: Describe the relationship between major CV risk factors and CVD outcomes Select

More information

ATP IV: Predicting Guideline Updates

ATP IV: Predicting Guideline Updates Disclosures ATP IV: Predicting Guideline Updates Daniel M. Riche, Pharm.D., BCPS, CDE Speaker s Bureau Merck Janssen Boehringer-Ingelheim Learning Objectives Describe at least two evidence-based recommendations

More information

Macrovascular Management. What s next beyond standard treatment?

Macrovascular Management. What s next beyond standard treatment? Macrovascular Management What s next beyond standard treatment? Are Lifestyle Modifications Still Relevant in Diabetic Patients? Diet Omega-6 and omega-3 fatty acids have been shown to improve CVD risk

More information

The Reduced Obese State: The Challenge of Weight Maintenance 2011 Annual CAN Conference November 17, 2011

The Reduced Obese State: The Challenge of Weight Maintenance 2011 Annual CAN Conference November 17, 2011 The Reduced Obese State: The Challenge of Weight Maintenance 2011 Annual CAN Conference November 17, 2011 Robert H. Eckel, M.D. Professor of Medicine Professor of Physiology and Biophysics Charles A. Boettcher

More information

Update on CVD and Microvascular Complications in T2D

Update on CVD and Microvascular Complications in T2D Update on CVD and Microvascular Complications in T2D Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of Miami Miller School of Medicine

More information

The Metabolic Syndrome: Is It A Valid Concept? YES

The Metabolic Syndrome: Is It A Valid Concept? YES The Metabolic Syndrome: Is It A Valid Concept? YES Congress on Diabetes and Cardiometabolic Health Boston, MA April 23, 2013 Edward S Horton, MD Joslin Diabetes Center Harvard Medical School Boston, MA

More information

Insulin resistance: targeting dyslipidemia beyond the LDL-cholesterol. Disclosures: Presentation outline

Insulin resistance: targeting dyslipidemia beyond the LDL-cholesterol. Disclosures: Presentation outline Insulin resistance: targeting dyslipidemia beyond the LDL-cholesterol Rocky Mountain Metabolic Syndrome Symposium May 14 th 21 Mori Krantz MD FACC Associate Professor, University of Colorado Director of

More information

2.5% of all deaths globally each year. 7th leading cause of death by % of people with diabetes live in low and middle income countries

2.5% of all deaths globally each year. 7th leading cause of death by % of people with diabetes live in low and middle income countries Lipid Disorders in Diabetes (Diabetic Dyslipidemia) Khosrow Adeli PhD, FCACB, DABCC Head and Professor, Clinical Biochemistry, The Hospital for Sick Children, University it of Toronto Diabetes A Global

More information

Accelerated atherosclerosis begins years prior to the diagnosis of diabetes

Accelerated atherosclerosis begins years prior to the diagnosis of diabetes Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician Risk for atherosclerosis is 2 4 times greater in patients with diabetes CVD accounts for 65% of diabetic mortality >5% of patients

More information

10/15/2012. Lessons Learned from Tim Russert: Investigating Residual Risk. Tim Russert: Residual CV Risk?

10/15/2012. Lessons Learned from Tim Russert: Investigating Residual Risk. Tim Russert: Residual CV Risk? Lessons Learned from Tim Russert: Investigating Residual Risk Peter H. Jones, MD, FACP Associate Professor Methodist DeBakey Heart and Vascular Center Baylor College of Medicine Houston, Texas Tim Russert:

More information

Joslin Diabetes Center Advances in Diabetes and Thyroid Disease 2013 Consensus and Controversy in Diabetic Dyslipidemia

Joslin Diabetes Center Advances in Diabetes and Thyroid Disease 2013 Consensus and Controversy in Diabetic Dyslipidemia Consensus and Controversy in Diabetes and Dyslipidemia Om P. Ganda MD Director, Lipid Clinic Joslin diabetes Center Boston, MA, USA CVD Outcomes in DM vs non- DM 102 Prospective studies; 698, 782 people,

More information

Ten Year Risk for CVD Event by Systolic HTN and CVD Risk Factors (Where s Age?)

Ten Year Risk for CVD Event by Systolic HTN and CVD Risk Factors (Where s Age?) Prevention and Treatment of CVD in Older Patients with Diabetes and Pre Diabetes: Hypertension and Dyslipidemia ASP Workshop on Diabetes Mellitus and Cardiovascular Disease in Older Adults Pentagon City

More information

Hyperlipidemia and Cardiovascular Disease. Kathmandu November 2010 Harold E. Lebovitz, MD, FACE

Hyperlipidemia and Cardiovascular Disease. Kathmandu November 2010 Harold E. Lebovitz, MD, FACE Hyperlipidemia and Cardiovascular Disease Kathmandu November 21 Harold E. Lebovitz, MD, FACE Diabetes and Lifetime Risk for CHD Adjusted cummula ative incidence.7.6.5 Men 67% 3%.7.6.5 Women Diabetes No

More information

Il rischio residuo nella persona con diabete: come individuarlo e come trattarlo?

Il rischio residuo nella persona con diabete: come individuarlo e come trattarlo? Il rischio residuo nella persona con diabete: come individuarlo e come trattarlo? Alberto Zambon University of Padova - Italy DISCLOSURE - CONFLICT OF INTEREST Prof. A. Zambon reports having received grants,

More information

How to Reduce Residual Risk in Primary Prevention

How to Reduce Residual Risk in Primary Prevention How to Reduce Residual Risk in Primary Prevention Helene Glassberg, MD Assistant Professor of Medicine Section of Cardiology Hospital of the University of Pennsylvania Philadelphia, PA USA Patients with

More information

Macrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy?

Macrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy? Macrovascular Residual Risk What risk remains after LDL-C management and intensive therapy? Defining Residual Vascular Risk The risk of macrovascular events and microvascular complications which persists

More information

Zuhier Awan, MD, PhD, FRCPC

Zuhier Awan, MD, PhD, FRCPC Metabolism, Atherogenic Properties and Agents to Reduce Triglyceride-Rich Lipoproteins (TRL) The Fifth IAS-OSLA Course on Lipid Metabolism and Cardiovascular Risk Muscat, Oman, February 8-11, 2019 Zuhier

More information

Cardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes

Cardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes Cardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes Following this presentation, you will be able to: Describe the relationship between major CV risk factors and CVD outcomes Select

More information

Placebo-Controlled Statin Trials EXPLAINING THE DECREASE IN DEATHS FROM CHD! PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN EXPLAINING THE DECREASE IN

Placebo-Controlled Statin Trials EXPLAINING THE DECREASE IN DEATHS FROM CHD! PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN EXPLAINING THE DECREASE IN PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING THE DECREASE

More information

How to Reduce CVD Complications in Diabetes?

How to Reduce CVD Complications in Diabetes? How to Reduce CVD Complications in Diabetes? Chaicharn Deerochanawong M.D. Diabetes and Endocrinology Unit Department of Medicine Rajavithi Hospital, Ministry of Public Health Framingham Heart Study 30-Year

More information

Decline in CV-Mortality

Decline in CV-Mortality Lipids id 2013 What s Changed? Christopher Granger, MD Disclosure Research contracts: AstraZeneca, GSK, Merck, Sanofi- Aventis, BMS, Pfizer, The Medicines Company, Medtronic Foundation, and Boehringer

More information

David Y. Gaitonde, MD, FACP Endocrinology DDEAMC, Fort Gordon

David Y. Gaitonde, MD, FACP Endocrinology DDEAMC, Fort Gordon David Y. Gaitonde, MD, FACP Endocrinology DDEAMC, Fort Gordon I have no actual or potential conflicts of interest in relation to this program or presentation. Raphael School of Athens, 1509-1511 Apply

More information

The Diabetes Link to Heart Disease

The Diabetes Link to Heart Disease The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM

More information

The Clinical Unmet need in the patient with Diabetes and ACS

The Clinical Unmet need in the patient with Diabetes and ACS The Clinical Unmet need in the patient with Diabetes and ACS Professor Kausik Ray (UK) BSc(hons), MBChB, MD, MPhil, FRCP (lon), FRCP (ed), FACC, FESC, FAHA Diabetes is a global public health challenge

More information

Approach to Dyslipidemia among diabetic patients

Approach to Dyslipidemia among diabetic patients Approach to Dyslipidemia among diabetic patients Farzad Hadaegh, MD, Professor of Internal Medicine & Endocrinology Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences

More information

ACCORD, ADVANCE & VADT. Now what do I do in my practice?

ACCORD, ADVANCE & VADT. Now what do I do in my practice? ACCORD, ADVANCE & VADT Now what do I do in my practice? Richard M. Bergenstal, MD International Diabetes Center Park Nicollet Health Services University of Minnesota Minneapolis, MN richard.bergenstal@parknicollet.com

More information

Comprehensive Treatment for Dyslipidemias. Eric L. Pacini, MD Oregon Cardiology 2012 Cardiovascular Symposium

Comprehensive Treatment for Dyslipidemias. Eric L. Pacini, MD Oregon Cardiology 2012 Cardiovascular Symposium Comprehensive Treatment for Dyslipidemias Eric L. Pacini, MD Oregon Cardiology 2012 Cardiovascular Symposium Primary Prevention 41 y/o healthy male No Medications Normal BP, Glucose and BMI Social History:

More information

Copyright 2017 by Sea Courses Inc.

Copyright 2017 by Sea Courses Inc. Diabetes and Lipids Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any means graphic, electronic, or

More information

2013 ACC AHA LIPID GUIDELINE JAY S. FONTE, MD

2013 ACC AHA LIPID GUIDELINE JAY S. FONTE, MD 2013 ACC AHA LIPID GUIDELINE JAY S. FONTE, MD How do you interpret my blood test results? What are our targets for these tests? Before the ACC/AHA Lipid Guidelines A1c:

More information

Treatment of Atherosclerosis in 2007

Treatment of Atherosclerosis in 2007 Treatment of Atherosclerosis in 2007 Szilard Voros, M.D. Medical Director Cardiovascular MR and CT Piedmont Hospital, Piedmont Hospital Our Paradigm Genotype Phenotype Environment Atherosclerotic Disease

More information

Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk

Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk Metabolic Syndrome Update 21 Marc Cornier, M.D. Associate Professor of Medicine Division of Endocrinology, Metabolism & Diabetes University of Colorado Denver Denver Health Medical Center The Metabolic

More information

A Fork in the Road: Navigating Through New Terrain

A Fork in the Road: Navigating Through New Terrain A Fork in the Road: Navigating Through New Terrain Carol Hatch Wysham, MD Clinical Associate Professor of Medicine University of Washington School of Medicine Section Head, Rockwood Center for Diabetes

More information

Metabolism, Atherogenic Properties and Agents to reduce Triglyceride-Rich Lipoproteins Manfredi Rizzo, MD, PhD

Metabolism, Atherogenic Properties and Agents to reduce Triglyceride-Rich Lipoproteins Manfredi Rizzo, MD, PhD Metabolism, Atherogenic Properties and Agents to reduce Triglyceride-Rich Lipoproteins Manfredi Rizzo, MD, PhD Associate Professor of Internal Medicine Faculty of Medicine, University of Palermo, Italy

More information

Dyslipidaemia. Is there any new information? Dr. A.R.M. Saifuddin Ekram

Dyslipidaemia. Is there any new information? Dr. A.R.M. Saifuddin Ekram Dyslipidaemia Is there any new information? Dr. A.R.M. Saifuddin Ekram PhD,FACP,FCPS(Medicine) Professor(c.c.) & Head Department of Medicine Rajshahi Medical College Rajshahi-6000 New features of ATP III

More information

What Else Do You Need to Know? Presenter Disclosure Information. Case 1: Cardiovascular Risk Assessment in a 53-Year-Old Man. Learning Objectives

What Else Do You Need to Know? Presenter Disclosure Information. Case 1: Cardiovascular Risk Assessment in a 53-Year-Old Man. Learning Objectives 9: 1:am Understanding Dyslipidemia Testing and Screening: Importance of Lipoprotein Particle Analysis SPEAKER Matthew Sorrentino, MD, FACC Presenter Disclosure Information The following relationships exist

More information

The Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk

The Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk Update 2013 Marc Cornier, M.D. Associate Professor of Medicine Division of Endocrinology, Metabolism & Diabetes Anschutz Health and Wellness Center University of Colorado School of Medicine Denver Health

More information

Placebo-Controlled Statin Trials Prevention Of CVD in Women"

Placebo-Controlled Statin Trials Prevention Of CVD in Women MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest

More information

The Metabolic Syndrome Update The Metabolic Syndrome Update. Global Cardiometabolic Risk

The Metabolic Syndrome Update The Metabolic Syndrome Update. Global Cardiometabolic Risk The Metabolic Syndrome Update 2018 Marc Cornier, M.D. Professor of Medicine Division of Endocrinology, Metabolism & Diabetes Anschutz Health and Wellness Center University of Colorado School of Medicine

More information

Statins for Cardiovascular Disease Prevention in Women: Review of the Evidence

Statins for Cardiovascular Disease Prevention in Women: Review of the Evidence Statins for Cardiovascular Disease Prevention in Women: Review of the Evidence Karen E. Aspry, M.D., M.S., ABCL, FACC Assistant Professor of Medicine (Clinical) Alpert Medical School of Brown University

More information

Cardiovascular Risk Reduction and Other Co-Morbidities in Type 2 Diabetes

Cardiovascular Risk Reduction and Other Co-Morbidities in Type 2 Diabetes Cardiovascular Risk Reduction and Other Co-Morbidities in Type 2 Diabetes Following this presentation, you will be able to: Describe the relationship between major CV risk factors and CVD outcomes Select

More information

Lipid Management: A Case-Based Approach. Overview. Simple Lipid Therapy Approach. Patients have lipid disorders of:

Lipid Management: A Case-Based Approach. Overview. Simple Lipid Therapy Approach. Patients have lipid disorders of: Lipid Management: A Case-Based Approach Patrick E. McBride, M.D., M.P.H. Professor of Medicine, Cardiovascular Medicine Associate Director, Preventive Cardiology Program UW School of Medicine and Public

More information

The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009

The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 Learning Objectives 1. Understand the role of statin therapy in the primary and secondary prevention of stroke 2. Explain

More information

Soo LIM, MD, PHD Internal Medicine Seoul National University Bundang Hospital

Soo LIM, MD, PHD Internal Medicine Seoul National University Bundang Hospital Soo LIM, MD, PHD Internal Medicine Seoul National University Bundang Hospital 1. Importance of Lowering LDL-Cholesterol in Diabetes Patients & Lipid Guidelines Prevalence of dyslipidemia in Korea Prevalence

More information

Lipid Management: Beyond LDL

Lipid Management: Beyond LDL Lipid Management: Beyond LDL Lisa R. Tannock MD Division of Endocrinology and Molecular Medicine University of Kentucky Overview Discuss the concept of residual risk Review current evidence-based medicine

More information

American Osteopathic College of Occupational and Preventive Medicine 2012 Mid-Year Educational Conference St. Petersburg, Florida

American Osteopathic College of Occupational and Preventive Medicine 2012 Mid-Year Educational Conference St. Petersburg, Florida The 21 st Century Paradigm Shift: Prevention Rather Than Intervention for the Treatment of Stable CHD The Economic Burden of Cardiovascular Diseases Basil Margolis MD, FACC, FRCP Director, Preventive Cardiology

More information

Cardiovascular Disease Prevention: Current Knowledge, Future Directions

Cardiovascular Disease Prevention: Current Knowledge, Future Directions Cardiovascular Disease Prevention: Current Knowledge, Future Directions Daniel Levy, MD Director, Framingham Heart Study Professor of Medicine, Boston University School of Medicine Editor-in-Chief, Journal

More information

Placebo-Controlled Statin Trials MANAGEMENT OF HIGH BLOOD CHOLESTEROL MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES

Placebo-Controlled Statin Trials MANAGEMENT OF HIGH BLOOD CHOLESTEROL MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest

More information

Triglyceride as Vascular Risk Factor

Triglyceride as Vascular Risk Factor Curriculum Vitae Name : Prof. Dr. dr. Idrus Alwi SpPD, KKV, FINASIM, FACP, FACC, FESC, FAPSIC Current Position : - President of the Indonesian Society of Internal Medicine Medical Student : Faculty of

More information

1. Which one of the following patients does not need to be screened for hyperlipidemia:

1. Which one of the following patients does not need to be screened for hyperlipidemia: Questions: 1. Which one of the following patients does not need to be screened for hyperlipidemia: a) Diabetes mellitus b) Hypertension c) Family history of premature coronary disease (first degree relatives:

More information

Slide 1. Slide 2. Slide 3. A Fork in the Road: Navigating Through New Terrain. Diabetes Standards of Care Then and Now

Slide 1. Slide 2. Slide 3. A Fork in the Road: Navigating Through New Terrain. Diabetes Standards of Care Then and Now Slide 1 A Fork in the Road: Navigating Through New Terrain Carol Hatch Wysham, MD Clinical Associate Professor of Medicine University of Washington School of Medicine Section Head, Rockwood Center for

More information

Tailored Statin Treatment for Type 2 Diabetes. Han, Ki Hoon Asan Medical Center University of Ulsan

Tailored Statin Treatment for Type 2 Diabetes. Han, Ki Hoon Asan Medical Center University of Ulsan Tailored Statin Treatment for Type 2 Diabetes Han, Ki Hoon Asan Medical Center University of Ulsan 1 Cardiovascular disease ; No1. death (2001) respiratory tract infection Other NCD S HIV/AIDS deaths during

More information

Novel HDL Targeted Therapies: The Search Continues Assoc. Prof. K.Kostner,, Univ. of Qld, Brisbane

Novel HDL Targeted Therapies: The Search Continues Assoc. Prof. K.Kostner,, Univ. of Qld, Brisbane Novel HDL Targeted Therapies: The Search Continues Assoc. Prof. K.Kostner,, Univ. of Qld, Brisbane Kostner, 2007 2008 LDL Target depends on your level of Risk Acute Plaque Rupture ACS (UA/NSTEMI/STEMI)

More information

The Metabolic Syndrome

The Metabolic Syndrome The Metabolic Syndrome Advances in Internal Medicine David D. Waters, MD May 21, 27 UCSF Metabolic Syndrome: Definition abdominal obesity increased waist circumference atherogenic dyslipidemia low HDL-C,

More information

Macrovascular Disease in Diabetes

Macrovascular Disease in Diabetes Macrovascular Disease in Diabetes William R. Hiatt, MD Professor of Medicine/Cardiology University of Colorado School of Medicine President, CPC Clinical Research Conflicts CPC Clinical Research (University-based

More information

Pathophysiology of Lipid Disorders

Pathophysiology of Lipid Disorders Pathophysiology of Lipid Disorders Henry Ginsberg, M.D. Division of Preventive Medicine and Nutrition CHD in the United States CHD is the single largest killer of men and women 12 million have history

More information

The New Gold Standard for Lipoprotein Analysis. Advanced Testing for Cardiovascular Risk

The New Gold Standard for Lipoprotein Analysis. Advanced Testing for Cardiovascular Risk The New Gold Standard for Lipoprotein Analysis Advanced Testing for Cardiovascular Risk Evolution of Lipoprotein Testing The Lipid Panel Total Cholesterol = VLDL + LDL + HDL Evolution of Lipoprotein Testing

More information

Glucose Control and Prevention of Cardiovascular Disease

Glucose Control and Prevention of Cardiovascular Disease Glucose Control and Prevention of Cardiovascular Disease Dr Peter A Senior BMedSci MBBS PhD FRCP(E) Associate Professor, Director Division of Endocrinology, University of Alberta Diabetes Update+, March

More information

PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN

PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING THE DECREASE

More information

Lessons from Recent Atherosclerosis Trials

Lessons from Recent Atherosclerosis Trials Lessons from Recent Atherosclerosis Trials Han, Ki Hoon MD PhD Asan Medical Center Seoul, Korea Change of concept Primary vs. secondary prevention Low risk vs. High risk High Risk CHD and equivalents CHD

More information

Prof. John Chapman, MD, PhD, DSc

Prof. John Chapman, MD, PhD, DSc Prof. John Chapman, MD, PhD, DSc Director of the Dyslipidemia and Atherosclerosis Research Unit of the National Institute for Health and Medical Research (INSERM) at the Pitié-Salpétrière Hospital in Paris

More information

Latest Guidelines for Lipid Management

Latest Guidelines for Lipid Management Latest Guidelines for Lipid Management Goals Recognize the differences between different guidelines Understand the effective strategies to tailor lipid lowering therapies based on evidence and guideline

More information

Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology

Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Disclosures In compliance with the accrediting board policies, the American Diabetes Association requires the

More information

Disclosure. No relevant financial relationships. Placebo-Controlled Statin Trials

Disclosure. No relevant financial relationships. Placebo-Controlled Statin Trials MANAGEMENT OF HYPERLIPIDEMIA AND CARDIOVASCULAR RISK IN WOMEN: Balancing Benefits and Harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial

More information

PIEDMONT ACCESS TO HEALTH SERVICES, INC. Guidelines for Screening and Management of Dyslipidemia

PIEDMONT ACCESS TO HEALTH SERVICES, INC. Guidelines for Screening and Management of Dyslipidemia PIEDMONT ACCESS TO HEALTH SERVICES, INC. Policy Number: 01-09-021 SUBJECT: Guidelines for Screening and Management of Dyslipidemia EFFECTIVE DATE: 04/2008 REVIEWED/REVISED: 04/12/10, 03/17/2011, 4/10/2012,

More information

Lipoprotein Particle Profile

Lipoprotein Particle Profile Lipoprotein Particle Profile 50% of people at risk for HEART DISEASE are not identified by routine testing. Why is LPP Testing The Most Comprehensive Risk Assessment? u Provides much more accurate cardiovascular

More information

Diabetic Dyslipidemia

Diabetic Dyslipidemia Diabetic Dyslipidemia Dr R V S N Sarma, M.D., (Internal Medicine), M.Sc., (Canada), Consultant Physician Cardiovascular disease (CVD) is a significant cause of illness, disability, and death among individuals

More information

Disclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease

Disclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures

More information

Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease

Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AMERICAN COLLEGE OF ENDOCRINOLOGY Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease Writing Committee Chair: Paul S. Jellinger,

More information

Metabolic Syndrome: An overview. Kevin Niswender MD, PhD Vanderbilt University School of Medicine

Metabolic Syndrome: An overview. Kevin Niswender MD, PhD Vanderbilt University School of Medicine Metabolic Syndrome: An overview. Kevin Niswender MD, PhD Vanderbilt University School of Medicine Setting the scene GB, 43 yo AA man followed for hypothyroidism returns on LT4 125 mcg/d and has a TSH=1.1

More information

Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden

Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Cardiovascular Disease Prevention (CVD) Three Strategies for CVD

More information

ATP III (Adult Treatment Panel III) CLASSIFICATION C IN ADULTS

ATP III (Adult Treatment Panel III) CLASSIFICATION C IN ADULTS LABORATORY AND RISK FACTORS OF ATHEROSCLEROSIS S R. Mohammadi Biochemist (Ph.D.) Faculty member of Medical Faculty RISK FACTORS FOR CHD Clinical Risk Factors Laboratory Risk Factors MAJOR CLINICAL RISK

More information

Weigh the benefit of statin treatment: LDL & Beyond

Weigh the benefit of statin treatment: LDL & Beyond Weigh the benefit of statin treatment: LDL & Beyond Duk-Woo Park, MD, PhD Heart Institute, University of Ulsan College of Medicine, Asan Medical, Seoul, Korea FOURIER Further cardiovascular OUtcomes Research

More information

Diabetes Mellitus: Implications of New Clinical Trials and New Medications

Diabetes Mellitus: Implications of New Clinical Trials and New Medications Diabetes Mellitus: Implications of New Clinical Trials and New Medications Estimates of Diagnosed Diabetes in Adults, 2005 Alka M. Kanaya, MD Asst. Professor of Medicine UCSF, Primary Care CME October

More information

Case Discussions: Treatment Strategies for High Risk Populations. Most Common Reasons for Referral to the Baylor Lipid Clinic

Case Discussions: Treatment Strategies for High Risk Populations. Most Common Reasons for Referral to the Baylor Lipid Clinic Case Discussions: Treatment Strategies for High Risk Populations Peter H. Jones MD, FNLA Associate Professor Methodist DeBakey Heart and Vascular Center Baylor College of Medicine Most Common Reasons for

More information

Treating Lipids for Prevention of CAD in Women: Matching Therapy to Risk

Treating Lipids for Prevention of CAD in Women: Matching Therapy to Risk TREATING LIPIDS FOR PREVENTION OF CAD IN WOMEN: MATCHING THERAPY TO RISK Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest

More information

CVD risk assessment using risk scores in primary and secondary prevention

CVD risk assessment using risk scores in primary and secondary prevention CVD risk assessment using risk scores in primary and secondary prevention Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil Disclosure Honoraria for consulting and speaker activities

More information

Update on Cholesterol Management: The 2013 ACC/AHA Guidelines

Update on Cholesterol Management: The 2013 ACC/AHA Guidelines Update on Cholesterol Management: The 2013 ACC/AHA Guidelines Ola Akinboboye MD MPH MBA Medical Director, Queens Heart institute Rosedale. Associate Professor of Clinical Medicine, Weill Medical College

More information

Recent Advances & Emerging Data in the Treatment of Hypertriglyceridemia. Michael Miller, MD, FACC, FAHA, FNLA

Recent Advances & Emerging Data in the Treatment of Hypertriglyceridemia. Michael Miller, MD, FACC, FAHA, FNLA Recent Advances & Emerging Data in the Treatment of Hypertriglyceridemia Michael Miller, MD, FACC, FAHA, FNLA Professor of Medicine, Epidemiology & Public Health University of Maryland School of Medicine

More information

Nicole Ciffone, MS, ANP-C, AACC Clinical Lipid Specialist

Nicole Ciffone, MS, ANP-C, AACC Clinical Lipid Specialist 1 Nicole Ciffone, MS, ANP-C, AACC Clinical Lipid Specialist New Cardiovascular Horizons Multidisciplinary Strategies for Optimal Cardiovascular Care February 7, 2015 2 Objectives After participating in

More information

Environmental. Vascular / Tissue. Metabolics

Environmental. Vascular / Tissue. Metabolics Global Risk Reduction--WINS Picking Mom and Dad-2016 Environmental Vascular / Tissue Metabolics Stop smoking-1b Physical activity-1b Weight control-1b Chelation therapy-3c Influenza vaccination-1b Blood

More information

Advances in Lipid Management

Advances in Lipid Management Advances in Lipid Management Kavita Sharma, MD Assistant Professor of Medicine, Division of Cardiology Clinical Director of the Lipid Management Clinics, The Ohio State University Wexner Medical Center

More information

Diabetes Mellitus: A Cardiovascular Disease

Diabetes Mellitus: A Cardiovascular Disease Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular

More information

Placebo-Controlled Statin Trials

Placebo-Controlled Statin Trials PREVENTION OF CHD WITH LIPID MANAGEMENT AND ASPIRIN: MATCHING TREATMENT TO RISK Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of

More information

No relevant financial relationships

No relevant financial relationships MANAGEMENT OF LIPID DISORDERS Balancing Benefits and harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial relationships baron@medicine.ucsf.edu

More information

How would you manage Ms. Gold

How would you manage Ms. Gold How would you manage Ms. Gold 32 yo Asian woman with dyslipidemia Current medications: Simvastatin 20mg QD Most recent lipid profile: TC = 246, TG = 100, LDL = 176, HDL = 50 What about Mr. Williams? 56

More information

No relevant financial relationships

No relevant financial relationships MANAGEMENT OF LIPID DISORDERS: WHERE DO WE STAND WITH THE NEW PRACTICE GUIDELINES? Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant financial relationships

More information

2/10/2016. Is it Time to Return to Cholesterol Goals for Optimal Patient Management? CON. Disclosures. Stipulations

2/10/2016. Is it Time to Return to Cholesterol Goals for Optimal Patient Management? CON. Disclosures. Stipulations Is it Time to Return to Cholesterol Goals for Optimal Patient Management? CON Donald M. Lloyd-Jones MD ScMFACC FAHA Eileen M. FoellProfessor Chair, Dept. of Preventive Medicine Senior Associate Dean Director,

More information

Safety of Anacetrapib in Patients with or

Safety of Anacetrapib in Patients with or Safety of Anacetrapib in Patients with or at Risk for Coronary Heart Disease Christopher P. Cannon, MD, Sukrut Shah, PhD, RPh, Hayes M. Dansky, MD, Michael Davidson, MD, Eliot A. Brinton, MD, Antonio M.

More information

Tuesday, October 18 3:30 p.m. 5:30 p.m. Convention Center: Rooms 315 & 316

Tuesday, October 18 3:30 p.m. 5:30 p.m. Convention Center: Rooms 315 & 316 Ambulatory Care PRN Focus Session New Developments in Hypertension and Dyslipidemia Management Activity No. 0217-0000-11-101-L01-P (Application-Based Activity) Tuesday, October 18 3:30 p.m. 5:30 p.m. Convention

More information

CLINICAL OUTCOME Vs SURROGATE MARKER

CLINICAL OUTCOME Vs SURROGATE MARKER CLINICAL OUTCOME Vs SURROGATE MARKER Statin Real Experience Dr. Mostafa Sherif Senior Medical Manager Pfizer Egypt & Sudan Objective Difference between Clinical outcome and surrogate marker Proper Clinical

More information

PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN

PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN 1980 to 2000: Death rate fell from: 542.9 to 266.8 per 100K men 263.3 to 134.4 per 100K women 341,745 fewer deaths from CHD in 2000 Ford ES, NEJM, 2007 47% from CHD treatments, 44% from risk factor modification

More information

Fasting or non fasting?

Fasting or non fasting? Vascular harmony Robert Chilton Professor of Medicine University of Texas Health Science Center Director of Cardiac Catheterization labs Director of clinical proteomics Which is best to measure Lower continues

More information